Healthcare Provider Details

I. General information

NPI: 1841470085
Provider Name (Legal Business Name): CHANDON E WILLIAMS LAC, CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WILLIAMSON ST STE F
MADISON WI
53703-4531
US

IV. Provider business mailing address

600 WILLIAMSON ST STE F
MADISON WI
53703-4531
US

V. Phone/Fax

Practice location:
  • Phone: 608-441-9355
  • Fax:
Mailing address:
  • Phone: 608-441-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number544-055
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: